Obamacare: One punt after another

Why do Republicans even bother trying to delay Obamacare? President Barack Obama’s doing it all by himself.

On Thursday, the Obama administration gave customers permission to pay their premiums as late as Dec. 31 for coverage that starts Jan. 1, and officially gave customers an extra week — until Dec. 23 — to sign up for January coverage.

Story Continued Below

The move was just the latest in a long list of extensions, delays and punts that have plagued the health care law.

Sure, Obama’s not doing the things Republicans have suggested — push off centerpieces like the individual mandate, or even put the entire law on hold for a year. But piece by piece, the Obama administration keeps giving itself extensions on smaller parts of the law, because there’s always some piece that isn’t quite ready.

It’s an attempt to put out fires — but it’s also a painful admission that, yes, there are fires.

The administration is also extending a critical program — the temporary high-risk pool for people with pre-existing conditions — through the end of January, to make sure none of them suddenly lose their health coverage because they can’t sign up for new Obamacare insurance by Jan. 1.

That’s after it postponed the employer coverage requirements for a year, delayed the online enrollment for the federal health insurance exchanges for small businesses, and told health insurers they can extend people’s coverage for an extra year — a last-minute attempt to un-cancel millions of canceled policies. It also delayed the Spanish-language website, even though Hispanics are a large proportion of the uninsured population. It even postponed next year’s enrollment period, pushing it conveniently past the November elections.

“This is the least shocking thing since the sun came up in the east. This is what they do,” said Douglas Holtz-Eakin of the American Action Forum. “They’ve essentially established that there’s going to be a rolling start to this thing.”

There was also a tone to Thursday’s announcement that was close to pleading for help, as the administration urged insurers to cut the new customers a bit of slack — looking the other way if they sign up a few days late, and making their coverage retroactive if they pay a bit late.

So far, the administration has refused to consider delaying big provisions like the individual mandate, and it has been cool to Democrats who want to extend the enrollment period past March 31 because of all the website problems. In those cases, insurers have been fighting hard against any change because they say any delay would throw off their pricing decisions, and possibly lead to big premium increases down the road.

And, of course, the one deadline that probably should have been delayed — the Oct. 1 of HealthCare.gov — wasn’t delayed, and the administration has been paying the price ever since.

But it may be hard for the administration to hold the line when it keeps moving so many other deadlines for the law — always a subtle admission that some component of Obamacare wasn’t quite ready when it was supposed to be.

“For all his attacks on our efforts, no one has done more to undermine the implementation of Obamacare than the president himself,” said Brendan Buck, a spokesman for House Speaker John Boehner.

House Energy and Commerce Committee Chairman Fred Upton dismissed the move in four words: “Another day, another delay.”

Obama administration officials insisted the latest delays are all aimed at a good cause: smoothing the path to Jan. 1, the one unmovable deadline, the day when the new health benefits begin under the health law. That’s when people will be able to get coverage for pre-existing conditions, for example, and subsidies to help them pay for the coverage if their incomes are low enough.

That’s true for people who had private health insurance that no longer meets the law’s standards, but it’s especially urgent for the 86,000 people with serious health conditions who can’t afford a break in coverage after the Pre-Existing Condition Insurance Plan, the stopgap program also created by Obamacare, ends.

“Both we and the issuers are focused on making sure … that every individual who is actively seeking coverage on the first of January, that that coverage is effective,” Mike Hash, director of the Department of Health and Human Services office of health reform, said in a conference call with reporters.

Outside health care experts weren’t surprised by the latest delays, but said they’re necessary to smooth the transition to the one deadline that really matters: Jan. 1. That’s when the new health insurance rules begin — including the coverage of people with pre-existing conditions — as well as the individual mandate that’s supposed to draw enough healthy people to make the new coverage stable.

“It’s not exactly news that the implementation has been rocky,” said Larry Levitt of the Kaiser Family Foundation. At the same time, he said, “the administration has been nimble in trying to deal with the challenges as they arise, not all of which were anticipated. They’ve been trying to put out fires as they erupt.”

The latest fires are all linked to the possibility that people wouldn’t be able to sign up for coverage in time for Jan. 1, possibly leaving sick people, and previously insured people, temporarily without health insurance — a nightmare scenario for a law that was supposed to expand health coverage.

The Obama administration has a long history of moving deadlines to try to get better results. Late last year, when it wasn’t getting enough states to build their own health insurance exchanges — the new marketplaces of private health coverage — HHS moved the deadline for states to make that decision.

Even after that, only 14 states and the District of Columbia agreed to set up their own exchanges, leaving the feds to set up the rest — through the HealthCare.gov website.

And there’s plenty of speculation that the March 31 enrollment deadline could still be extended to give people more time to sign up, given all the website troubles, although HHS hasn’t said it will do that and it’s not clear that it can.

But as much grief as the Obama administration will get from Republicans over the latest delays, Levitt said the administration probably had no choice — because it has to solve the crises that have been stacking up while it approaches the one deadline that can’t be moved.

“It’s not surprising that they’re trying to deal with all the issues that are backing up as we approach New Year’s eve,” Levitt said. “Before, you could kind of say, ‘oh, those deadlines aren’t really that important.’ Jan. 1 is the one that really matters.”